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HAEMODIALYSIS CHAPTER 5
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© ANZDATA Registry Figure 5.1 Stock and Flow of Haemodialysis Patients 2006 - 2010 20062007200820092010 Australia Patients new to HD20622021214920561986 First Dialysis Treatment17771730178817031676 Previous Dialysis (PD)253268321314276 Failed Transplant3223403934 Transplanted427405535495548 Deaths10361163120112261138 Never Transplanted9621084113811501070 Previous Transplant7479637668 Transfer to Peritoneal Dialysis534436487428328 Patients Dialysing (HD) at 31 December72167592791982328527 Patients Dialysing (HD) at Home at 31 December894949950972964 % of all Home Dialysis (HD and PD) Patients31% 30%31%32% New Zealand Patients new to HD407380394429391 First Dialysis Treatment327311320360326 Previous Dialysis (PD)7057665958 Failed Transplant10128107 Transplanted5160696147 Deaths181177236205 Never Transplanted166167219192182 Previous Transplant1510171323 Transfer to Peritoneal Dialysis179146158118147 Patients Dialysing (HD) at 31 December12311325134314811545 Patients Dialysing (HD) at Home at 31 December322327330377422 % of all Home Dialysis (HD and PD) Patients30%31%30%32%34%
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© ANZDATA Registry Figure 5.2
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© ANZDATA Registry Figure 5.3 Stock and Flow of Haemodialysis Patients Australia 2006 - 2010 Number (%) Age Groups 20062007200820092010 New Patients * 00-14 years13 (1%)9 (0%)13 (1%)9 (0%)13 (1%) 15-24 years34 (2%)45 (2%)42 (2%)45 (2%)42 (2%) 25-34 years77 (4%)94 (5%)101 (5%)89 (4%)75 (4%) 35-44 years198 (10%)187 (9%)172 (8%)176 (9%)166 (8%) 45-54 years296 (14%)315 (16%)345 (16%)312 (15%)308 (16%) 55-64 years454 (22%)437 (22%)447 (21%)442 (21%)430 (22%) 65-74 years532 (26%)485 (24%)541 (25%)513 (25%)472 (24%) 75-84 years413 (20%)405 (20%)431 (20%)411 (20%)397 (20%) >=85 years45 (2%)44 (2%)57 (3%)59 (3%)83 (4%) Total2062 (100%)2021 (100%)2149 (100%)2056 (100%)1986 (100%) Patients Dialysing 00-14 years7 (0%)5 (0%)10 (0%)9 (0%)10 (0%) 15-24 years94 (1%)98 (1%)88 (1%)91 (1%)98 (1%) 25-34 years301 (4%)305 (4%)290 (4%)293 (4%)286 (3%) 35-44 years697 (10%)737 (10%)692 (9%)692 (8%)684 (8%) 45-54 years1142 (16%)1210 (16%)1274 (16%)1314 (16%)1310 (15%) 55-64 years1568 (22%)1618 (21%)1719 (22%)1775 (22%)1841 (22%) 65-74 years1753 (24%)1804 (24%)1894 (24%)1980 (24%)2052 (24%) 75-84 years1469 (20%)1602 (21%)1685 (21%)1766 (21%)1854 (22%) >=85 years185 (3%)213 (3%)267 (3%)312 (4%)392 (5%) Total7216 (100%)7592 (100%)7919 (100%)8232 (100%)8527 (100%) Primary Renal Disease * Glomerulonephritis463 (22%)482 (24%)462 (21%)504 (25%)417 (21%) Analgesic Nephropathy48 (2%)46 (2%)45 (2%)39 (2%)38 (2%) Hypertension307 (15%)319 (16%)322 (15%)285 (14%)278 (14%) Polycystic Disease134 (6%)127 (6%)125 (6%)123 (6%)130 (7%) Reflux Nephropathy62 (3%)56 (3%)59 (3%)61 (3%)42 (2%) Diabetic Nephropathy681 (33%)642 (32%)746 (35%)680 (33%)722 (36%) Miscellaneous252 (12%)217 (11%)233 (11%)230 (11%)240 (12%) Uncertain115 (6%)132 (7%)157 (7%)134 (7%)119 (6%) Total2062 (100%)2021 (100%)2149 (100%)2056 (100%)1986 (100%) * New patients receiving first haemodialysis treatment
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© ANZDATA Registry Figure 5.4
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© ANZDATA Registry Figure 5.5 Stock and Flow of Haemodialysis Patients New Zealand 2006 - 2010 Number (%) Age Groups20062007200820092010 New Patients * 00-14 years3 (1%) 5 (1%)2 (0%)1 (0%) 15-24 years15 (4%)21 (6%)19 (5%)10 (2%)12 (3%) 25-34 years30 (7%)17 (4%)15 (4%)24 (6%)12 (3%) 35-44 years33 (8%)45 (12%)34 (9%)54 (13%)39 (10%) 45-54 years92 (23%)63 (17%)84 (21%)89 (21%)96 (25%) 55-64 years96 (24%)100 (26%)117 (30%)103 (24%)108 (28%) 65-74 years94 (23%)88 (23%)89 (23%)92 (21%)82 (21%) 75-84 years40 (10%)39 (10%)30 (8%)52 (12%)38 (10%) >=85 years4 (1%) 1 (0%)3 (1%) Total407 (100%)380 (100%)394 (100%)429 (100%)391 (100%) Patients Dialysing 00-14 years2 (0%)3 (0%) 4 (0%) 15-24 years32 (3%)39 (3%)38 (3%)41 (3%)45 (3%) 25-34 years88 (7%)80 (6%)76 (6%)90 (6%)89 (6%) 35-44 years150 (12%)160 (12%)149 (11%)162 (11%)164 (11%) 45-54 years247 (20%)261 (20%)275 (20%)309 (21%)328 (21%) 55-64 years347 (28%)364 (27%)373 (28%)403 (27%)427 (28%) 65-74 years269 (22%)297 (22%)293 (22%)315 (21%)322 (21%) 75-84 years87 (7%)108 (8%)126 (9%)147 (10%)152 (10%) >=85 years9 (1%)13 (1%)10 (1%)11 (1%)14 (1%) Total1231 (100%)1325 (100%)1343 (100%)1481 (100%)1545 (100%) Primary Renal Disease * Glomerulonephritis92 (23%)89 (23%)72 (18%)96 (22%)88 (23%) Analgesic Nephropathy1 (0%)3 (1%)1 (0%) Hypertension39 (10%)43 (11%)33 (8%)44 (10%)38 (10%) Polycystic Disease23 (6%)15 (4%)14 (4%)18 (4%)11 (3%) Reflux Nephropathy7 (2%)8 (2%)9 (2%)3 (1%)6 (2%) Diabetic Nephropathy184 (45%)163 (43%)204 (52%)212 (49%)202 (52%) Miscellaneous32 (8%)47 (12%)46 (12%)41 (10%)35 (9%) Uncertain29 (7%)12 (3%)15 (4%)14 (3%)11 (3%) Total407 (100%)380 (100%)394 (100%)429 (100%)391 (100%) * New patients receiving first haemodialysis treatment
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© ANZDATA Registry Figure 5.6
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© ANZDATA Registry Figure 5.7
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© ANZDATA Registry Figure 5.9
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© ANZDATA Registry Figure 5.10 Blood Flow Rates (mls/minute) 2006 - 2010 Country No. Pts * Mls/Minute <200200-249250-299300-349350-399>400 Aust December 2010 852430.50%3.50%14.30%57.90%20.10%3.70% December 2009 823110.60%3.50%14.60%57.50%19.80%4% December 2008 7919 0.70%4.40%16.20%54.80%20%3.90% December 2007 759020.50%4.50%18.40%53.20%19.50%3.90% December 2006 721510.40%4.50%19.30%52.30%19.10%4.40% NZ December 2010 1545 0.30%6.20%25.40%49.30%16.70%2.10% December 2009 148010.30%6.40%24.90%45.90%20.20%2.30% December 2008 1343 0.40%7.50%31.70%41.20%17.30%1.90% December 2007 1325 0.50%6.60%28.80%41.10%21%2.10% December 2006 1231 0.40%6.90%26.30%44.80%19.50%2.10%
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© ANZDATA Registry Figure 5.11 Blood Flow Rate by Type of Access December 2010 Blood Flow Rate AustraliaNew Zealand AVFAVGCVC *AVFAVGCVC <20022 (.3%)-17 (1.5%)2 (.2%)1 (1.3%)2 (.6%) 200-249204 (3.1%)26 (3.5%)67 (5.7%)73 (6.5%)2 (2.6%)21 (6.1%) 250-299805 (12.2%)119 (15.9%)298 (25.6%)199 (17.7%)24 (30.8%)169 (49.4%) 300-3493793 (57.4%)467 (62.5%)679 (58.2%)582 (51.7%)48 (61.5%)132 (38.6%) 350-3991498 (22.7%)115 (15.4%)101 (8.7%)238 (21.2%)3 (3.8%)17 (5%) >=400289 (4.4%)20 (2.7%)4 (.3%)31 (2.8%)-1 (.3%) Total 6611 (100%)747 (100%)1166 (100%)1125 (100%)78 (100%)342 (100%)
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© ANZDATA Registry Figure 5.12
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© ANZDATA Registry Figure 5.14 Duration and Number of Sessions Per Week December 2010 Sessions Per week Hours of Each Treatment Total <444>4-4.5>4.5-5>5-5.5>5.5 Australia <=3343 (4.4%)3240 (41.8%)1638 (21.1%)2198 (28.4%)138 (1.8%)192 (2.5%)7749 (100%) >3-<542 (7.8%)88 (16.3%)51 (9.4%)105 (19.4%)9 (1.7%)245 (45.4%)540 (100%) >=571 (45.8%)33 (21.3%)2 (1.3%)9 (5.8%)1 (.6%)39 (25.2%)155 (100%) Total456 (5.4%)3361 (39.8%)1691 (20%)2312 (27.4%)148 (1.8%)476 (5.6%)8444 (100%) New Zealand <=322 (1.6%)510 (37.7%)272 (20.1%)448 (33.1%)30 (2.2%)71 (5.2%)1353 (100%) >3-<58 (5.3%)33 (22%)10 (6.7%)54 (36%)10 (6.7%)35 (23.3%)150 (100%) >=514 (50%)8 (28.6%)2 (7.1%)3 (10.7%)-1 (3.6%)28 (100%) Total44 (2.9%)551 (36%)284 (18.5%)505 (33%)40 (2.6%)107 (7%)1531 (100%)
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© ANZDATA Registry Figure 5.15
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© ANZDATA Registry Figure 5.21 Haemodialysis Percentage ≥ 5 Sessions per Week By Australian State and Country Australia New Zealand QldNSW/ACTVicTasSANTWA Dec-1049 (3.1%)26 (.9%)48 (2.2%)3 (2.1%)8 (1.4%)6 (1.5%)15 (1.9%)28 (1.8%) Dec-0940 (2.6%)27 (1%)39 (1.8%)2 (1.4%)6 (1.1%)-10 (1.3%)28 (1.9%) Dec-0850 (3.4%)23 (.9%)45 (2.2%)2 (1.6%)8 (1.7%)1 (.3%)12 (1.6%)34 (2.5%) Dec-0757 (4.2%)26 (1%)53 (2.6%)1 (.8%)9 (1.9%)-14 (2%)27 (2.1%)
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© ANZDATA Registry Figure 5.22 Haemodialysis Percentage ≥ 4.5 Hours Per Session Three Sessions per Week By Australian State and Country Australia New Zealand QldNSW/ACTVicTasSANTWA Dec-10809 (50.8%)1820 (65.9%)744 (33.7%)77 (53.8%)137 (24.4%)295 (73.9%)198 (25.2%)816 (53.2%) Dec-09769 (49.9%)1717 (64.5%)661 (31.3%)75 (53.6%)133 (25%)304 (79.6%)191 (24.8%)748 (51%) Dec-08716 (49.4%)1713 (66.1%)640 (31%)52 (41.6%)105 (21.8%)276 (76.7%)177 (23.2%)650 (48.7%) Dec-07678 (49.7%)1659 (66%)611 (30.5%)43 (35%)121 (25.2%)278 (83.2%)186 (26.1%)724 (55.1%)
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© ANZDATA Registry Figure 5.23 Haemodialysis Percentage >12 Hours per Week By Australian State and Country Australia New Zealand QldNSW/ACTVicTasSANTWA Dec-10978 (61.3%)2034 (73.9%)954 (43.2%)89 (62.7%)166 (29.5%)308 (77.4%)252 (32%)984 (64.5%) Dec-09942 (61.2%)1959 (73.5%)870 (41.2%)87 (62.1%)162 (30.6%)304 (80.2%)237 (30.8%)900 (61.2%) Dec-08880 (60.6%)1930 (74.4%)837 (40.6%)59 (46.8%)129 (26.7%)285 (78.7%)216 (28.3%)780 (58.4%) Dec-07841 (62.3%)1873 (74.5%)804 (40.1%)53 (42.7%)151 (31.5%)282 (84.7%)222 (31.1%)819 (62.5%)
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© ANZDATA Registry Figure 5.24 Haemodialysis at 90 Days Patient Survival Censored for Transplant 1999 - 2010 % [95% Confidence Interval] No. of Patients Survival 6 months1 year3 years5 years Australia 1999-2001396693 [92, 94]87 [85, 88]65 [64, 67]48 [47, 50] 2002-2004423493 [92, 94]86 [85, 87]65 [64, 67]47 [45, 48] 2005-2007525592 [91, 93]86 [85, 87]65 [63, 66]47 [46, 49] 2008-2010517093 [92, 93]87 [86, 88]-- New Zealand 1999-200172693 [91, 95]87 [84, 89]62 [58, 66]41 [37, 45] 2002-200486494 [92, 96]88 [85, 90]65 [62, 68]44 [41, 48] 2005-200794794 [92, 95]89 [86, 90]65 [62, 68]44 [39, 48] 2008-2010101793 [91, 95]90 [87, 91]--
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© ANZDATA Registry Figure 5.29 Haemodialysis at 90 Days Patient Survival - Diabetic / Non Diabetic Censored for Transplant 1999 - 2010 % [95% Confidence Interval] Survival No. of Patients 6 months1 year3 years5 years Australia Non Diabetic (n=10,869) 1293992 [92, 93]86 [86, 87]67 [66, 68]50 [49, 51] Diabetic (n=4,806) 568693 [92, 94]87 [86, 87]62 [61, 64]43 [41, 44] New Zealand Non Diabetic (n=1,436) 194093 [92, 94]88 [86, 89]67 [65, 69]48 [45, 51] Diabetic (n=1,237) 161495 [94, 96]89 [87, 90]62 [60, 65]39 [35, 42]
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© ANZDATA Registry Figure 5.32 Haemodialysis at 90 Days Patient Survival - By Age Group Censored for Transplant 1999 - 2010 % [95% Confidence Interval] Age GroupsNo. of Patients Survival 6 months1 year3 years5 years Australia 0-39 years214398 [97, 99]96 [95, 97]87 [85, 89]80 [77, 82] 40-59 years582496 [95, 96]92 [91, 93]77 [76, 78]63 [61, 65] 60-74 years666892 [91, 93]85 [84, 86]62 [61, 63]43 [42, 45] >=75 years399087 [85, 88]77 [76, 79]46 [44, 48]25 [23, 26] New Zealand 0-39 years48499 [98, 100]96 [94, 98]83 [78, 87]72 [65, 77] 40-59 years149195 [94, 96]91 [89, 92]73 [71, 76]52 [48, 55] 60-74 years125793 [91, 94]86 [84, 88]57 [54, 60]33 [30, 37] >=75 years32284 [79, 87]71 [66, 76]33 [27, 39]17 [12, 23]
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© ANZDATA Registry Figure 5.35 Haemodialyser Membrane Types Dialyser Membrane Type Flux Square Metres Total <1.01.0-1.41.5-1.71.8-1.9>1.9 Australia CELLULOSE ACETATELOW 1...12 CELLULOSE TRIACETATEHIGH..4144664 DIACETATELOW..4.26 POLYAMIXHIGH 144725.20022772 POLYAMIXLOW.744.54105 POLYETHERSULFONEHIGH..6101252359 POLYNEPHRONHIGH....46 POLYSULPHONEHIGH.15.121138 POLYSULPHONELOW 510.9599209 POLYSULPHONE-HELIXONEHIGH.718.307710644859 Total 7794783329935778460 New Zealand POLYAMIXHIGH.357.378438 POLYAMIXLOW.570.137212 POLYSULPHONEHIGH...5.5 POLYSULPHONELOW 2..93114209 POLYSULPHONE-HELIXONEHIGH.405.18769661 Total 24131272856981525
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© ANZDATA Registry Figure 5.36 Number of Patients at end of 2010 by HD Modality NTNSW/AC T VicQldSAWATasNZTotal Haemodiafiltration0288172078983352841,003 Haemodialysis - Hollow 4052,6692,3801,4905237491281,3079,651 Haemofiltration012025000946 Total4052,9692,3971,7226128321631,60010,700
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© ANZDATA Registry Figure 5.42 - Australia
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© ANZDATA Registry Figure 5.64 Urea Reduction Ratio - Prevalent Patients Three Sessions per Week - December 2010 Hours per Session Urea Reduction Ratio % < 65>=65Total Australia <4 hours53 (18.1%)240 (81.9%)293 4 hours246 (8.3%)2715 (91.7%)2961 >4-5 hours262 (7.4%)3265 (92.6%)3527 >5 hours27 (11.7%)204 (88.3%)231 Total588 (8.4%)6424 (91.6%)7012 New Zealand <4 hours6 (40.0%)9 (60.0%)15 4 hours149 (32.3%)313 (67.7%)462 >4-5 hours178 (28.2%)453 (71.8%)631 >5 hours11 (15.5%)60 (84.5%)71 Total344 (29.2%)835 (70.8%)1179
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© ANZDATA Registry Figure 5.79 Vascular Access at First Treatment Haemodialysis as Initial Modality 1-Jan-2007 to 31-Dec-2010 2007200820092010 AVF or AVG CVC AVF or AVG CVC AVF or AVG CVC AVF or AVG CVC Australia QLD149 (41%)212 (59%)139 (36%)249 (64%)152 (41%)220 (59%)138 (41%)202 (59%) NSW/ACT198 (35%)367 (65%)187 (33%)374 (67%)177 (36%)312 (64%)183 (36%)331 (64%) Vic193 (47%)217 (53%)186 (47%)209 (53%)213 (50%)216 (50%)197 (45%)243 (55%) Tas14 (41%)20 (59%)12 (35%)22 (65%)16 (43%)21 (57%)19 (61%)12 (39%) SA66 (58%)48 (42%)71 (54%)61 (46%)89 (61%)57 (39%)54 (41%)79 (59%) NT20 (31%)44 (69%)39 (49%)41 (51%)27 (46%)32 (54%)25 (46%)29 (54%) WA60 (33%)122 (67%)67 (34%)131 (66%)66 (39%)105 (61%)51 (31%)113 (69%) New Zealand 78 (25%)233 (75%)73 (23%)247 (77%)111 (31%)249 (69%)81 (25%)245 (75%)
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© ANZDATA Registry Figure 5.91 Prevalent Vascular Access at 31-Dec-2010 Dec 2007Dec 2008Dec 2009Dec 2010 AVF or AVG CVC AVF or AVG CVC AVF or AVG CVC AVF or AVG CVC Australia QLD1232 (89%)148 (11%)1283 (87%)192 (13%)1373 (88%)195 (12%)1423 (88%)195 (12%) NSW/ACT2142 (84%)394 (16%)2197 (84%)421 (16%)2245 (83%)448 (17%)2358 (85%)426 (15%) Vic1790 (89%)221 (11%)1857 (90%)215 (10%)1895 (89%)227 (11%)1964 (89%)255 (11%) Tas113 (88%)16 (12%)110 (82%)24 (18%)118 (80%)30 (20%)128 (88%)18 (12%) SA436 (90%)47 (10%)430 (88%)61 (12%)485 (90%)55 (10%)506 (89%)61 (11%) NT297 (89%)38 (11%)328 (91%)34 (9%)366 (96%)17 (4%)367 (92%)33 (8%) WA554 (77%)164 (23%)561 (73%)205 (27%)592 (76%)182 (24%)614 (78%)178 (22%) New Zealand 991 (75%)334 (25%)983 (73%)360 (27%)1111 (75%)370 (25%)1203 (78%)342 (22%)
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© ANZDATA Registry Figure 5.109 Proportion (%) of Prevalent Patients aged ≥ 65 years Treated with Home Haemodialysis 2006 - 2010 State 20062007200820092010 Queensland3.50%3.60%4.10%4%4.30% New South Wales4.90%5.40%5.50%5.40%5.20% Australian Capital Territory4.20%3.80%4.40%5.70%6.60% Victoria2.10%2.90%3.50%3.40% Tasmania3%2.60%2.70%2.40%3.30% South Australia- --- 0.80% Northern Territory2.10%2% 2.30%1.90% Western Australia0.30% 0.90%1.10%1.80% Australia 3.10%3.40%3.80% 3.90% New Zealand 6.60%8.10%8.20%8.60%8.50%
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